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Provider Information for 1861755571



DR. DEVIN LYNN DAVIDSON D.M.D.

Gender: MALE

Individual NPI: 1861755571

Calendar Last Updated: 2014-01-15

Details

Name Value
NPI 1861755571
Enumeration Date 2012-06-18
NPI Type 1 - Individual
Sole Proprietor NO
Status Active
Mailing Address 777 N 500 W SUITE 106
PROVO, UT 84601-1541
United States

Phone: 801-636-5106 | Fax:
View Map External Link
Primary Practice Address 777 N 500 W SUITE 106
PROVO, UT 84601-1541
United States

Phone: 801-636-5106 | Fax:
View Map External Link
Taxonomy
Primary Taxonomy Selected Taxonomy State License Number
Yes 122300000X - Dentist UT 8634531-9922
Other Identifiers
Issuer State Number
Endpoint Information
Endpoint Type Endpoint Endpoint Description Use Content Type Affiliation Endpoint Location